Archive for category Foot Treatment

Foot Blisters

Dec 19

Posted by efootpain in Foot Blister, Foot Blister, Foot Pain, General, Medicine | 1 Comment

Foot blisters are common pathology in our active society.  Blisters occur due to skin friction or abrasion in the foot or ankle.  The body produces fluid beneath the skin and increases in size leading to pain, irritation, and sometimes infection.  Blisters can be seen from people wearing ill-fitting shoes, not wearing proper hosiery, athletes prone to over training or “breaking in” new shoes, sweaty feet, allergic reactions, diabetic patients with neuropathic disease, and excessive sandal use.  The foot blisters can cause significant symptoms of redness, soreness, large fluid filled “bubbles”, and can lead to more serious problems as ulcerations and infection.

Foot blisters can be prevented and treated by a podiatrist.  Keep the feet dry with foot powder and changing socks/ hosiery to reduce moisture.  Make sure to “break in” a shoe or custom orthotic to reduce the friction applied from the new device.  Smaller blisters may be treated with soaks, topical antibiotic, and bandages.  Larger blisters may have to be drained to reduce the fluid pressures and pain in the foot.  This may require a visit to a professional podiatrist to reduce risk of infection and ulceration.  The podiatrist may prescribe a topical and/or oral antibiotic, soaking regime, custom orthotic to reduce reoccurrence, proper hosiery, and shoe recommendations.

Tags: , , , , , , , , ,

Podiatrist shoes

Dec 16

Posted by efootpain in Devices, Foot Care, General, Orthotics | No Comments

Podiatrists use shoes and orthotics in the treatment of biomechanical problems. The podiatrist is a specialist in the medical treatment of the foot and ankle.  In the course of keeping patients healthy and active, the podiatrist shoe recommendations are an integral part in their healing process. There are many brands and categories of podiatric shoes patients must choose in their shopping experience.  These shoes include dress type, walking, running, cross training, casual, sandals, slippers, high to low cut heels, and diabetic custom shoes.  An orthotic foot support can be supplemented with the podiatric shoe for added shock support, comfort, biomechanical control, and reduction of pressure.

The podiatrist can perform foot examinations, biomechanical evaluation, gait evaluation, and diagnostic tests as diagnostic musculoskeletal ultrasound and x-rays to clinically determine the most appropriate podiatric shoe for the patient.  Some podiatrists may have digital technology machines that can scan a digital impression to view the 3- dimensional structures of the foot and ankle.  The podiatrist may recommend certain retail stores or pedorthist to help aid in measurements.  A brannock device is used to obtain an accurate assessment of the foot length, width, and circumference of the foot. The podiatrist shoe should have supportive arch, firm heel counter, torsional stability, adequate fit and depth to accommodate for a custom orthotic (if prescribed), and proper material suited for the patients needs of motion and breathability.  By having a proper fitting and functional podiatric shoe, the patient is able to live a more active and pain-free lifestyle.

Tags: , , , , , , , , , ,

Diabetic Foot

Dec 13

Posted by efootpain in Callus, Corns, Diabetic Foot, Diabetic Foot Care, Diabetic Foot Complications, Foot Care, Foot Treatment, Medicine | No Comments

Diabetic foot disease is an unfortunate complication in patients with diabetes.  Diabetes Mellitus (DM) is a disease where the body is unable to produce an adequate amount of insulin.  This reduction in insulin leads to an increase in blood sugar in the body that may lead to many complications associated with diabetes.  The diabetic feet complications are one of the unfortunate areas affected by this disease.

Patients with diabetes mellitus may have poor circulation, loss of feeling or peripheral neuropathy in the hands and feet, thickened toenails, hardened calluses, ulcerations or sores on the bottom or top of the feet, and increase risk of amputation.  In addition, the diabetic foot patient may be imbalanced leading to biomechanical deformities as bunions, hammertoes, collapsed mid-foot arch, equines or tight heel cord, and charcot

Neuroarthropathy.

The diabetic foot should be evaluated and treated by a professional podiatrist.  The clinical exam is important to evaluate the skin texture, toenails, pulses for circulation, testing for nerve damage, muscle strength weakness, biomechanical stability, and gait testing.  Diagnostic tests as x-rays, diagnostic ultrasound, Doppler studies, nerve tests, blood tests, wound cultures, and MRI or CT scans are other exams used to help the podiatrist gain accuracy in the diabetic foot patient.

Treatment of the diabetic foot is a team effort.  It is very important to communicate with the medical doctor, endocrinologist, therapist, dietician, pedorthist shoe maker, and podiatric surgeon.  Education is the most important factor in foot health.  In order to maintain and reduce complications of the diabetic feet, the patient should begin by following these simple instructions:

  1. Take care of the blood sugar and keep it within control.
  2. Examine and clean your feet daily.
  3. Wear the proper shoes and custom inserts recommended by your podiatrist.
  4. Protect the diabetic foot from extreme temperatures of the different seasons.
  5. Continue with proper exercise to improve blood flow and reduce sugar levels.
  6. Maintain diabetic foot appointments with the podiatrist for check-up.

Tags: , , , ,

Diabetic foot Care

Dec 10

Posted by efootpain in Callus, Corns, Diabetic Foot Care, Foot Pain, Foot Treatment, Fungus Toenails, Medicine | No Comments

Diabetic foot care is an important factor in the overall health care of a diabetic patient.  Podiatrists help reduce the risk factors of diabetic patients that may lead to many debilitating complications.  These complications include mild conditions as fungal toenails, ingrown toenails, calluses, corns, and small fissures or cuts in the foot.  More severe problems include soft tissue and bone infections, foot ulcerations, leg venous ulcerations, and amputation of the toes or feet.

Diabetic foot care is recommended by Northwest podiatry centers as preventative treatment for long term care of the foot and ankles.  Podiatrists treatment involve debridement of painful and thick fungal toenails, debridement of callous tissue that are pre-ulcerative, fitting of special diabetic shoes and inserts, x-rays and diagnostic ultrasound studies to review the proper biomechanical structures of the feet.  Diabetic patients must follow the foot care treatment protocol recommended by their podiatrist to enjoy the benefits of overall medical health.

Tags: , , , , ,

Podiatrist

Dec 7

Posted by efootpain in Board Certified Podiatrist, Foot Pain, Foot Treatment, Medicine, Podiatrist Medical Education, Podiatrist Medical School, Podiatrist Training | No Comments

A Podiatrist is a specialist in the medical, biomechanical, and surgical treatment of diseases in the foot and ankle.  In the United States, the podiatrist is licensed as a Doctor of Podiatric Medicine or D.P.M.  Training of a podiatrist requires attendance in a four year Podiatry Medical School program.  In addition, further training of up to 2 to 3 years of residency training in an accredited hospital or university institution.  Many podiatry medical schools are affiliated with medical school programs.  There are approximately eight podiatric medical schools in the United States.  They are located in California, Arizona, Iowa, Ohio, Illinois, Florida, Pennsylvania, and New York.

Entrance into a college of podiatric medicine requires at least 90 semester hours of college credit at an accredited institution.  The actual minimum semester credit hour requirements for all colleges of podiatric medicine include the following prerequisites according the American association of Colleges of Podiatric Medicine.  These courses include biology, chemistry, organic chemistry, physics, and English.  Most of these courses require between 8 to 12 semester hours depending on the podiatric medical school with laboratory courses included.

The podiatrist medical education is focused on the medical, biomechanical, and surgical aspects of treatment of the foot and ankle.  Rotations in various specialties are integrated with their training including vascular surgery, family medicine, internal medicine, radiology, pathology, anesthesiology, emergency medicine, general surgery, orthopedic surgery, psychology, endocrinology, plastic surgery, and neurology.  By learning all aspects of human body the podiatrist is well suited to recognize medical symptoms vital to obtaining the correct diagnosis and treatment regime.

Podiatrists are licensed in all 50 states, the District of Columbia, and Puerto Rico. Podiatrists practice in individual or group practices.  Hospital and surgical center affiliation and credentialing may be obtained in order for the podiatrist to perform medical and surgical procedures.  In addition, podiatrists may also work with HMOs, PPOs, Extended care facilities, health professional schools, Veterans affairs departments, Municipal health departments, and the Public health service department.

Podiatrists strive to become board certified in their specialty that are classified under board certified in primary podiatric medicine and biomechanics, podiatric foot surgery, podiatric reconstructive rear foot surgery, and diabetes prevention and treatment of the diabetic foot wounds and foot wear.  Podiatric board certification requires the graduation from an accredited podiatric medical school, completion of an approved podiatry residency, practice experience by years, case submissions, and passing a written, computer based, and oral examination.  In addition, CME (continuing medical education) is essential and mandatory in many states in which podiatrists are required to obtain up to 50 hours of education a year to expand their knowledge and learn new techniques.

Podiatrists treat a vast array of medical problems in their daily practice.  Many podiatrists work in the office or clinic, hospital, and surgical setting.  They treat patients with pathology as heel pain (plantar fasciitis), ingrown toenail infection, onychomycosis (fungal nails), dry skin, athletes foot, fractures of the foot or ankle, plantars warts, flatfeet, tendon ruptures and tendonitis, arthritis, gout, neuroma (Mortons neuroma), soft tissue masses, running injuries, varicose veins, nerve disorders (as tarsal tunnel syndrome), hammertoes (corns and calluses), bunions, tailors bunions (bunionettes), diabetic foot care and ulcerations, pediatric heel pain, cellulites.

The podiatric patient may not only have foot and ankle pathology but also related medical diseases as diabetes, parkinson’s disease, fibromyalgia, multiple sclerosis that may contribute to the foot and ankle disease and requires a team of other medical specialties for complete health care.   The team approach in the care of the medical patient may require consultations or treatment by internal medicine, vascular, endocrinology, eye doctors, neurologists, physical therapists, dieticians, and many other specialties depending on the diagnosis.

Podiatrists not only treat patients medically but also surgically when indicated.

They use a vast array of surgical equipment as surgical screws and plates called internal fixation, external fixation devices as mini and large ring fixators, bone grafts, skin grafts, joint implants for the toes, ankles, or subtalar joint, arthroscopy equipment,

And Endoscopy equipment.  There are continuing innovations medical and surgical field for the care of the podiatric patient.

Diagnostic tests are also ordered by the podiatrist in order to obtain the most accurate diagnosis.  Some equipment may be in the office as the X-ray, diagnostic ultrasound, tuning fork, vascular testing equipment, and neurological testing equipment.  Other tests ordered may be performed at other facilities as the CT scan, MRI, flouroscan, bone scan, blood work, and some vascular and neurological exams.  These diagnostic measurements are important in the diagnosis of the podiatric patient.

The podiatrist treatment regime may consist of performing conservative care or surgical care.  The podiatrist is able to prescribe medications, perform manipulations of the foot and ankle, casting for broken bones, casting for custom orthotics, injections, physical therapy, debridement of tissue and toenails.  The podiatrist surgical care is also well rounded that may include ingrown toenail surgery, wart removal, bunion, hammertoes, diabetic debridement, amputations, external fixation devices, fracture and dislocation repair, reconstructive foot and ankle surgery, ankle arthroscopy.  The podiatrist is a well rounded medical professional and is important in the health care effort in providing patients with long term health and activity.

Tags: , ,

Ankle

Nov 24

Posted by efootpain in Ankle Bone, Ankle Fracture, Ankle Injury, Ankle Pain, Ankle Sprain, Ankle Sprain Treatment, Exercises, Foot Treatment, Glossary | No Comments

The ankle is a ginglymus joint that connects the foot to the lower leg and that helps propel the body through the gait cycle. The ankle joint is also known as the talocrural joint which aids in stability, shock absorption, and proprioception. The ankle joint is a crucial weight-bearing joint which allows the foot to move up and down upon the lower leg. (The side to side motion of the foot is primarily provided by the subtalar joint which is located just below the ankle joint).

The ankle is made up of a very complex anatomic network of bones and soft tissue structures. The ankle comprises of three bones. Two of the bones are located in the lower leg called the tibia and fibula, and one bone is located in the foot called the talus. There are two bony prominences that are felt on the inside and outside of the ankle joint which are called the medial malleolus and lateral malleolus. The medial malleolus is a direct extension of the tibia and is located and felt on the inside of the foot. The bony prominence located on the outside of the ankle is called the lateral malleolus and it is a continuation of the fibula. There are three articular facets located within the ankle joint, which are made up of cartilage that allows range of motion within the joint.

The soft tissue structural anatomy is made up of the ankle joint capsule, syndesmosis, and ligaments. The ankle joint capsule harbors synovial fluid within the ankle joint to allow range of motion within the joint. The syndesmosis is located just above the ankle joint line and is made up of the anterior inferior tibiofibular, posterior inferior tibiofibular, and interosseous ligaments as well as the interosseous membrane. These soft tissue structures contribute to the stability of the ankle.

The ligamentous structures that help hold the bones of the ankle joint together are divided into two categories called the lateral collateral ligaments and the medial collateral ligaments. The lateral collateral ligaments are comprised of the anterior talofibular, calcaneofibular, and posterior talofibular ligaments. The medial collateral ligaments, also called the deltoid ligaments, are divided into superficial and deep portions. The superficial deltoid ligaments are made up of the tibionavicular, calcaneotibial, and superficial posterior talotibial ligaments. The deep deltoid ligaments are made up of the anterior talotibial and deep posterior talotibial ligaments. These ankle joint ligaments are very durable, but not completely resistant to injuries.

The most common injuries seen in the ankle joint are sprains, ligament ruptures, and bone fractures. These injuries can be treated with or without surgery. If these injuries are not treated properly, they can lead to arthritis within the ankle joint.

Ankle sprains are the most common injuries that are seen in emergency rooms at the hospitals. Ankle sprains occur when there is a sudden twist or rotation of the foot upon the lower leg. This puts strain on the ligaments of the ankle joint which can cause different types of structural problems. An ankle sprain occurs when the ligaments of the ankle become overstretched or even partially torn during excessive motion. If the sprain or excessive motion is great enough, the ligament or ligaments can even rupture. An avulsion fracture can occur when the ligament does not rupture, but the bone breaks with the ligament still attached. These problems are very different and are treated in different ways.

The most common ankle sprain that occurs is when the foot falls inward, called an inversion ankle sprain. This direction of excessive motion usually damages the lateral collateral ligaments of the ankle and the pain is located on the outside of the ankle. The first and most common ankle ligament that gets damaged is the anterior talofibular ligament. When the sprain is greater, it can cause damage to the calcaneofibular ligament or even more severe, the posterior talofibular ligament.

Another type of ankle sprain is called an eversion ankle sprain. Here, the foot falls outward. This can lead to pain on the inside part of the ankle. The superficial deltoid and sometimes deep deltoid ligament can become injured depending on the severity of the sprain.

Ankle sprains are commonly treated without surgery. The conservative treatment follows the pneumonic PRICE. The P stands for protection, the R for rest, the I for ice, the C for compression, and the E for elevation. Protection can consist of a cast, or a walking boot. Rest is important to allow the sprained ligaments to heal. Ice is important to decrease the inflammation that occurs during the healing process of the sprain. Compression is equally important to reduce the swelling. Elevation also reduces the swelling that occurs during the healing process. The process can take up to 3-5 weeks depending on the severity of the injury, followed by a rigorous physical therapy regiment.

Surgery is indicated when the pain has not been resolved in a reasonable period of time, or when the ligaments are ruptured, or when there is a loss of ankle stability. Some surgeries involve direct primary repair of the ruptured ligament or ligaments. Tendon transfers, tendon grafts, and rerouting of ligaments can be used when a direct repair is not enough to stabilize the ankle. An avulsion type fracture can be repaired with the use of anchors that reattach the tendon to the bone.

When the injury is more severe than an ankle sprain, the articular cartilage within the ankle joint can become damaged. The location of the talus bone within the ankle joint predisposes itself to impaction injuries that occur during a fall from a height or excessive rotation within the ankle joint. When this occurs, the articular cartilage of the talus can become weakened or even fractured. When the cartilage gets weakened, it can form large cyst like lesions called Osteochondral Dessicans. This osteochondral injury to the talus is a very difficult injury to diagnose and is often not seen on radiographs. A Magnetic Resonance Imaging may be required to help diagnose the injury and define the treatment plan.

When an Osteochondral Dessicans or osteochondral lesion occurs, conservative measures do not have very high success rates and surgical intervention is usually required. The surgical treatment of osteochondral defects varies greatly. The main purpose of surgery is to resolve pain which may involve replacing the cartilage that is damaged with healthy cartilage from a different location within the body or from a cadaver.

When an ankle injury occurs at very high velocity, the bones of the ankle can become deformed and lead to fracture. The bones that most commonly break within the ankle are the tibia and fibula. The orientation that the bones break depends on the forces that are applied and the direction in which it occurred in.

An “open” ankle fracture is a serious injury that involves a broken bone within the ankle in the presence of a break in the skin. There is a high chance of infection with an open ankle fracture and so treatment involves multiple procedures and intravenous antibiotics. A “closed” ankle fracture is less serious and is described by any fracture of bones within the ankle in which the skin is still totally intact.

There are many classification systems that are used by surgeons to help guide the treatment of ankle fractures. A common and easy system that is used to describe ankle fracture is the Danis Weber classification, which is based on the location of the fracture within the fibula bone. A Danis Weber A is a fracture on the fibula that is below the ankle joint. A Danis Weber B is a fracture on the fibula that occurs at the ankle joint. Finally, a Danis Weber C is a fracture on the fibula that occurs above the ankle joint.

The management of ankle fractures is determined by the amount of displacement of the fractured bone, any loss of stability within the ankle joint, and if an open fracture is present. Any ankle fracture can have fracture blisters associated with this traumatic event. Fracture blisters can contain blood or serous fluid within the blister which can be treated by draining them or by deroofing the blister and applying a sterile protective bandage.

The nonsurgical treatment is implemented when there is no loss of ankle stability, fracture displacement or breaks in the skin. The nonsurgical management consists of ice, elevation, compression, and immobilization with a below the knee cast.

Surgery is indicated when the ankle fracture is considered “open,” or when there is a loss of stability, or when there is displacement of the fracture bones. Surgery is usually delayed for 7-10 days to reduce the swelling that occurs with ankle fractures. The fractured bones are fixed with screws, plates, K-wires, Steinmann pins, and external fixation devices. The post operative period is determined by the time is takes for healing of the bone and soft tissues.

Another associated disorder that can occur with or without ankle fractures is an injury to the syndesmosis of the ankle joint. The syndesmosis helps control the stability of the ankle joint which is located just above the tibia and fibula articulation. An injury to the syndesmosis displays an excessive amount of space within the ankle joint making it unstable and painful. Surgery is performed to stabilize the syndesmosis and ankle joint by using screws and suture material.

Any injury that occurs within the ankle joint can lead to arthritis with or without the proper treatment. The chances of arthritis forming within the ankle are decreased by the length of time treatment starts and the severity of injury. Arthritis can be displayed within the ankle joint by forming bony exostoses and decreasing ankle joint space leading to decrease range of motion. This can be treated with cortisone injections temporarily or by surgical fusion or total ankle replacement.

Flat Feet

Nov 24

Posted by efootpain in Causes & Symptoms, Devices, Flat Feet, Flat Foot, Foot Pain, Foot Treatment, Glossary, Rigid Flat Feet | No Comments

“Flat Feet” is a widely used generic medical term that describes some type of decrease in the height of the arch that is located on the inside of the foot. In some cases, a person with flat feet has a slight decrease in arch height, while in other cases, there is no arch visualized. Flat feet are considered normal in infancy and in young children until 8-10 years of age. Around this time, an arch should be identified. However; most people with flat feet never develop pain.

There are many different terms that are used to describe a person with flat feet. Some of these include pes planus, pes valgus, equino valgus, collapsing pes valgo planus, and talipes calcaneovalgus. Although flat feet is a broad term, it is a very complex disorder that not only affects the arch but also other parts of the foot and/or ankle. The most commonly associated disorders with flat feet are bunions, hammertoes, heel pain, midfoot collapses and dislocations, and an everted or valgus position of the heel and/ or ankle as well as equinus. Since there are so many associated disorders that can cause symptoms with flat feet, the associated disorders should also be treated concurrently when treating flat feet.

In general, there are two very common presentations of flat feet which are termed “flexible” and “rigid”. A “flexible” flat foot means that the arch collapses upon weight bearing of the foot while the arch of the foot is visible when the foot is not touching the ground. Flexible flat feet commonly occur in the pediatric or adolescence and can continue into adulthood. If symptomatic and not properly treated, a flexible flatfoot can become stiff or rigid and potentially develop in a more severe condition. The second common presentation of flat foot is termed “rigid” which means that the height of the arch is the same whether or not the foot is touching the ground during weight-bearing. Rigid flat feet can be caused by many factors including arthritis, tarsal coalitions, and congenital vertical talus.

The severity of symptoms that occur with flat feet varies from person to person as well as the location on the lower leg and foot. The symptoms are not defined by how low the height of the arch is but rather the adaptive changes in bone, tendons, and ligaments. At times, there are patients that have no visible arch height, who are asymptomatic, while patients with a very slight decrease in their arch height have severe symptoms.

After diagnosing flat feet by a physical examination and radiographs as well as other imaging modalities, the treatment regiment should begin promptly. There are non-surgical and surgical treatment protocols to help treat the pediatric as well as the adult acquired flat foot. The conservative treatments are based on controlling the pathological movements of the bones, ligaments, and tendons. This is done by custom molded foot orthotics, and/ or foot and ankle braces. Rest, ice, compression, elevation and an organized physical therapy regiment helps decrease the tenderness, inflammation, and swelling that occurs.

When considerable effort of conservative treatment has failed to relieve symptoms, surgical intervention is indicated. The type of procedure that is performed is highly variable because each flat foot is unique to each other. The principles behind the vast array of surgical procedures available are based on to correct each area of soft tissue, ligament, and bone that is contributing to the pathologic symptoms. The surgical procedures can range from implants, soft tissue releases, and tendon transfers to osteotomies and fusions of bones with or without bone grafts. The recovery period is dependent on the surgical procedure performed which can range from 8- 12 weeks followed by physical therapy.

PLANTAR FACIITIS – BEYOND THE PAIN

Nov 6

Posted by efootpain in Foot Pain, Heal Pain/Plantar | No Comments

Plantar fasciitis is the most common cause of heel pain. Usually, symptoms occur with activity after resting – getting out of bed in the morning, getting out of a car after driving, getting up after sitting for a while. All of these situations tend to cause immediate pain. In general, shorter periods of standing and walking may actually provide some relief after the fascia loosens up. However, if you are on your feet all day, the pain usually returns.

The causes of plantar fasciitis are due to a variety of factors. Weight, age, physical stress and foot alignment are among the culprits.

Patients who are overweight may be more likely to develop plantar fasciitis; though, the condition can occur in all weight classes. However, overweight patients may not find relief as easily. The stress of additional weight on the feet, especially the heel, can cause the condition and continue to aggravate it.

Age can affect plantar fasciitis, as well. As a patient gets older, the plantar fascia does not stretch as well as it used to. The fat pad on the bottom of the foot tends to thin out with age. This may cause more stress on the heel, since it affects the combined shock-absorbing ability of the fascia and the fat pad.

Other situations that can lead to the development of plantar fasciitis include:

* A walking or jogging program or during prolonged standing, such as a job with little sit-down time, that adds pressure to the foot.
* The use of ill-fitted shoes and shoes that do not provide appropriate support or shock absorption.
* A switch from a higher-heeled to a lower-heeled shoe that causes tightness in the calf muscle.
* Feet that are malaligned or pronated, which is an excessively flattened foot structure, as well as a high-arched foot may cause abnormality in a patient’s gait.

DO IT YOURSELF TREATMENTS

If a patient begins at-home treatment soon after symptoms start, the painful symptoms due to plantar fasciitis may be improved. Appropriate treatments include:

* Resting the foot/feet;
* Cutting back on athletic activities, or cross-training with such activities as swimming or cycling that put less stress on the foot;
* Applying ice to the area either directly after the activity for 15-20 minutes or icing the heel on a daily basis twice a day to try to reduce some of the inflammation;
* Stretching exercises for the gastrocnemius-soleus calf muscle and the plantar fascia;
* Wearing appropriate shoe gear, especially with heel support. An anti-pronatory style running shoe might be beneficial. Over-the-counter arch supports seem to work better than just a heel pad in relieving discomfort.
* Taking over-the-counter anti-inflammatory medication, such as Advil, Aleve, Tylenol;
* Starting a diet if over-weight. Any weight loss will help to reduce pressure on the feet and strain of the plantar fascia.

DIAGNOSTIC TESTING

The main standards used to try to identify a diagnosis of plantar fasciitis include x-rays, diagnostic ultrasound and magnetic resonance imaging (MRI). In addition, computed axial tomography (CT) scans and bone scans can be utilized to help rule out other associated bone conditions or fractures involving the heel. And importantly, nerve conduction testing with an Electromyography (EMG), Nerve Conduction Velocity (NCV) and neuro-sensory testing may need to be done to rule out a neurological cause of the heel pain.

MEDICAL TREATMENTS

Once the appropriate diagnosis has been made, physical therapy is often prescribed and can be quite beneficial. Options within therapy include icing, ultrasound, iontophoresis, deep massage and an aggressive stretching and strengthening program. If the pain has been long-standing and resistant to these modalities, the Graston technique can be employed. This method utilizes stainless steel tools to detect and resolve adhesions in muscles, tendons and fascia.

Another treatment option is the night splint. This removable “boot” can be worn while the patient is sleeping. It helps to maintain tension on the plantar fascia and stretch it out through the night. This frequently helps to resolve the morning pain one gets when getting out of bed.

Orthotics are yet another option. These custom-made devices can realign and compensate for foot deformity and help to redistribute pressure throughout the foot more evenly.

Trigger point injections of corticosteroids can often relieve the inflammation associated with plantar fasciitis. The injection needs to be given in an appropriate fashion within the plantar fascia. It should not be administered into the heel pad, as this would shrink the heel pad and reduce some of the soft shock absorption that is provided. Usually up to three injections can be given over the course of time to try to relief the discomfort.

TREATING PLANTAR FASCIITIS WITH SHOCK WAVE

If more conservative treatments have been tried without success, a patient and his podiatrist may consider extra-corporeal shockwave therapy (ESWT). This treatment option should be considered prior to surgical options for release of the plantar fascia. There are two types of ESWT. Low-energy shockwave uses a series of several treatments, usually not too painful and with no need for anesthesia. The high-energy shockwave tends to be more effective, but can be painful when administered. Therefore, a regional nerve block or general anesthesia is needed to lessen the patient’s discomfort. Shockwave therapy is thought to work by causing micro-trauma to the area of the plantar fascia that is affected by the fasciitis. The body then sees this micro-trauma as an area that needs to be healed. The healing response causes blood vessels and other nutrients to be brought to the affected area, thereby healing the micro-trauma, as well as healing the long-standing plantar fasciitis.

SURGERY

Surgery should be a treatment of last resort. Still, surgical intervention is needed in 1% to 2% of the population to improve nonresponsive plantar fasciitis. Studies show a success rate in the 60% to 70% range. The surgical option can take the form of a release of the plantar fascia done through an endoscope, which can be more of a closed, minimally-invasive procedure. The more traditional open procedure frequently releases the fascia, as well as removing the bone spur. Patients still may experience pain or weakening of the arch as a side effect of the surgical procedure.

Bad habits make your feet suffer.

Sep 4

Posted by efootpain in Foot Treatment | No Comments

Bad habits make your feet suffer.

Related Posts Plugin for WordPress, Blogger...